Effects of fixed low-dose warfarin, aspirin-warfarin combination therapy, and dose-adjusted warfarin on thrombogenesis in chronic atrial fibrillation
Effects of fixed low-dose warfarin, aspirin-warfarin combination therapy, and dose-adjusted warfarin on thrombogenesis in chronic atrial fibrillation
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DOI：
10.1161/01.str.31.4.828
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发表时间：
2000-04-01
期刊：
影响因子：
8.3
通讯作者：
Lip, GYH
中科院分区：
文献类型：
--
作者：
Li-Saw-Hee, FL;Blann, AD;Lip, GYH
背景和目的：最近的临床试验已经证实，调整剂量华法林（国际标准化比值[INR] 2.0到3.0）在减少非瓣膜性心房颤动（AF）患者缺血性卒中方面非常有效。我们假设引入固定剂量的华法林单独或联合阿司匹林（300mg）可以使止血标志物正常化，即血浆纤维蛋白d-二聚体tan指数)，纤溶酶原激活物抑制剂-1 （PAI-1，纤维蛋白溶解指数），纤维蛋白原和血管性血变因子（vWf，内皮功能障碍指数），其方式与调整剂量华法林（目标INR 2.0至3.0）相当。方法：61例未接受任何抗血栓治疗的房颤患者（44例男性，平均+/- sd年龄64 +/- 19岁）前瞻性随机分为3个治疗组中的1个：华法林（2mg） （n=23；组I）、华法林1mg + 300mg阿司匹林联合治疗（n=21；组2）或华法林2mg + 300mg阿司匹林联合治疗（n= 17；组3）。所有3个AF组的受试者在性别、年龄和血压方面都是匹配的。在随机化前、随机化后2周和8周，采集血样，顺序测量血浆纤维蛋白d -二聚体、PAI-1、纤维蛋白原和vWf的变化。所有患者随后给予调整剂量华法林治疗（2期），并在6周后采集额外的血液样本。结果：与60例年龄、性别匹配的健康对照组相比，预处理后的窦性心律患者纤维蛋白原（P=0.025）、vWf（P =0.025）水平显著升高
Background and Purpose-Recent clinical trials have established that adjusted-dose warfarin (international normalized ratio [INR] 2.0 to 3.0) is highly effective in the reduction of ischemic stroke in patients with nonvalvular atrial fibrillation (AF). We hypothesized that the introduction of fixed low-dose warfarin alone or in combination with aspirin (300 mg) could normalize hemostatic markers, namely plasma fibrin D-dimer tan index of thrombogenesis), plasminogen activator inhibitor-1 (PAI-1, an index of fibrinolysis), fibrinogen, and von Willebrand factor (vWf, an index of endothelial dysfunction), in a manner comparable to adjusted-dose warfarin (target INR 2.0 to 3.0).Methods-Sixty-one patients with AF (44 men, mean+/-SD age 64 +/- 19 years) who were not receiving any antithrombotic therapy were prospectively randomized into 1 of 3 treatment groups: warfarin (2 mg) (n=23; group I), combination 1 mg warfarin plus 300 mg aspirin (n=21; group 2) or combination 2 mg warfarin plus 300 mg aspirin (n = 17; group 3). Subjects from all 3 AF groups were matched for sex, age, and blood pressure. Blood samples were taken for sequential measurements for changes in plasma fibrin D-dimer, PAI-1, fibrinogen, and vWf before and at 2 and 8 weeks after randomization (phase 1). All patients were subsequently offered adjusted-dose warfarin therapy (phase 2), and an additional blood sample was taken 6 weeks later.Results-When pretreatment results were compared with those from 60 age- and sex-matched healthy control subjects in sinus rhythm, there were significant elevations in levels of fibrinogen (P=0.025), vWf(P